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1、Surveillance ofDevice Related Infection in Intensive Care Unit ICU导管相关感染监测(A version for training purpose only,the data involved is not reflecting the real situation)2021/10/23 星期六1National Nosocomial Infections Surveillance(NNIS)system全国院内感染监测系统2021/10/23 星期六2Purpose目的Monitor the infection rates 监控
2、感染率Benchmark with NNIS System 与NNIS标竿Determine trends 确定趋势Identify outbreak 定义暴发Facilitate comparisons 易于比较Link monitored rates and prevention efforts 感染率与预防效果的联系Reduce devices related infection in hospital 减少医院导管等装置的感染率2021/10/23 星期六3Population at risk 危险人群 All patients has been admitted in ICU for
3、 48 hours.入ICU48小时的病人Follow patients for 48 hours after discharge from ICU.病人转出ICU 需继续跟踪48小时2021/10/23 星期六4Device-associated infections 导管相关感染Urinary catheter-associated Urinary tract infection(CA-UTI)导尿管相关的尿路感染Central line-associated Bloodstream infection(CA-BSI)中心静脉导管相关的血流感染Ventilator-associated P
4、neumonia(VAP)呼吸机相关的肺炎2021/10/23 星期六5Denominator data 分母资料Count at 12 midnight in everyday 每天在午夜12点计算Total number of patients admission 所有病人Patient-days 病人日Urinary catheter-days 导尿管日Central line-days 中心静脉插管日Ventilator-days 呼吸机日2021/10/23 星期六6Surveillance methods 调查方法调查方法on going review each patient i
5、n ICU.持续观察ICU的每个病人by reviewing Doctors progress notes,Nursing notes,Physiotherapists notes,XR report,charts,MAR forms,conversations with nurses and physicians 查看医生病程、护理记录、理疗单、X线检查、CT/MAR。医生护士的会话by reviewing laboratory data.查看实验室数据 2021/10/23 星期六72021/10/23 星期六82021/10/23 星期六92021/10/23 星期六10Define d
6、evice-related infection 定义导管相关感染定义导管相关感染By using standard CDC definitions that include laboratory&clinical data使用CDC的标准包括实验室和临床资料2021/10/23 星期六11Definitions VAPHad device within 48-hrs period before onset of infection Systemic S/SRespiratory S/SChest X-R evidenceLaboratory results2021/10/23 星期六12Def
7、initions CA-BSI Had device within 48-hrs period before onset of infectionClinical manifestationsCommon skin contaminant from 2 blood culturesNo apparent source for BSI except the catheter2021/10/23 星期六13Definitions CA-UTI Symptomatic UTIS/S of UTI+ve urine culture=10Asymptomatic bacteriuria+ve urine
8、 culture=10No S/S of UTI552021/10/23 星期六14Calculate Device-associated infection ratesNumber of device-associated infection for a specific site x 1000Number of device-days2021/10/23 星期六15Calculate Device utilization ratios Number of device-daysNumber of patient-days2021/10/23 星期六16VAP Surveillance in
9、 ICUABNo.of VAP627Patient days13734872Ventilator days 6432694Infection rates9.33(50)10.02(50)DU ratios0.47 500.55 75()NNIS device associated infection percentile NNIS device utilization percentile2021/10/23 星期六17CA-BSI Surveillance in ICU ABNo.of CA-BSI 08Patient days13734872CVC days4023216Infection
10、 rates0(10)2.49(25)DU ratios0.26 10 0.6650()NNIS device associated infection percentile NNIS device utilization percentile2021/10/23 星期六18CA-UTI Surveillance in ICUABNo.of UTI2312Patient days13734872Urinary Cath days11484711Infection rates20.03(90)2.55(25)DU ratios0.84 500.97.90()NNIS device associa
11、ted infection percentile NNIS device utilization percentile2021/10/23 星期六19Pathogens Isolated-VAPNo.of infection6No.of isolate9GM-ve microorganism66.6%Proteus,Pseudnmonas,Acinetobacter,Klebsiella,EnterobacterGM+ve microorganism33.3%-haem.Strep.,MSSA,Strep.pneumoniaeFungus0%2021/10/23 星期六20Pathogens Isolated CA-UTINo.of infection23No.of isolate28GM-ve microorganism 92.9%E.Coli(50%),Klebsiella(14.3%),Proteus(14.3%),Enterobacter(10.7%),M.morganii(3.6%)GM+ve microorganism 3.6%Enterococcus spp.Fungus3.6%Candida albicans2021/10/23 星期六21Thank you2021/10/23 星期六22